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Sr. Director of Claims

Company: Evolent Health
Location: Louisville
Posted on: February 15, 2020

Job Description:

It's Time For A Change Your Future Evolves Here Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and celebrate individual talents and team wins. We have fun while working hard and Evolenteers often make a difference in everything from scrubs to jeans. Are we growing? Absolutely about 40% in year-over-year revenue growth in 2018 . Are we recognized? Definitely. We have been named one of Becker's 150 Great Places to Work in Healthcare in 2016, 2017, 2018 and 2019, and One of the 50 Great Places to Work in 2017 by Washingtonian. We recognize employees that live our values, give back to our communities each year, and are champions for bringing our whole selves to work each day. If you're looking for a place where your work can be personally and professionally rewarding, don't just join a company with a mission. Join a mission with a company behind it. This position is located in Louisville, KY. The selected applicant would need to reside, or be open to relocation. What You'll Be Doing: This position is accountable for the leadership, management and oversight of the Claims Department to ensure timely and accurate adjudication of claims for health care services, received from contracted and non-contracted providers and to ensure all Federal, State and Client requirements are met. - Manage inventory and assignments of the claims team across assigned clients and lines of business to balance workloads and resources - Measure, manage and constantly improve production and quality results of the claims staff - Ensure achievement of claims related client SLAs (turnaround time, accuracy, auto adjudication, re-touch rates, etc.) - Assess re-touch of claims (adjustments, appeals, etc.) to continuously reduce re-touches and improve service to customers - Support and lead team members in the identification and implementation of improved processes, increased automation, higher claims accuracy and enhanced customer experience - Collaborate internally and externally to address operational and technology issues impacting customers to suggest and implement innovative methods to help alleviate backlogs and ensure optimal use of resources - Coach and develop staff to align career paths with employee goals, ongoing succession planning and build relationships and trust - Ongoing communication of company, organizational, operational and technical information to all team members, including regular department, team and management meetings - Lead and/or contribute to various projects representing the claims operation, ensuring deliverables are met on time and work is of high integrity. - Represent claims operations in new client implementations, new product line implementations, prospective client presentations and RFPs - Lead office/site operations representing Health Plan Services in co-locations and satellite locations. - Lead multiple Health Plan Services functions as assigned - Represent claims operations in client meetings, audits, performance and services reviews, and maintain positive relationships with key customer contacts The Experience You'll Need; - Bachelor degree preferred or equivalent work experience - Extensive experience in health insurance claims processing with a minimum of 7 years management experience. - Experience directly managing staff, including performance management, employee development and recruiting, having managed large teams of 100+ associates - Medicaid and Medicare experience desired - Knowledge of health insurance, HMO and managed care principles - Experience developing and managing budgets - Ability to lead/manage multiple large scale projects - Strong leadership and management skills - Excellent interpersonal, oral and written communication skills - Strong attention to detail and organization - Able to work independently; strong analytic skills - Strong computer skills Include the physical demands of the job, including bending, sitting, lifting and driving. For example, while performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach with hands and arms. Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.

Keywords: Evolent Health, Louisville , Sr. Director of Claims, Executive , Louisville, Kentucky

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